Infection with high-risk (HR) human papillomaviruses (HPVs), especially HPV 16, is considered a necessary step in the genesis of cervical intraepithelial neoplasia (CIN), a group of precursor lesions for cervical cancer (CC). Our recent data demonstrated that women with higher folate status have the ability to clear HR-HPV infections, including HPV 16, and that HR-HPV positive women, especially HPV 16-positive women who have lower folate status, are significantly more likely to be diagnosed with CIN (OR=9, p <0.0001). If supplementation with folic acid can enhance the clearance of HPV 1.6 and decrease the incidence of CIN, it would represent a clinically significant intervention. We propose to investigate the effect of supplementation with folic acid on the clearance of HPV 16 and of any of 17 other specific types of HPVs, and on the incidence of CIN, by conducting a 12-month double-blind, placebo-controlled trial of supplementation with 5 mg of folic acid per day. Primary hypotheses: 1) The proportion of women who clear a given specific type of HPV (HPV 16 and any other type present) during the 12 month study period will be higher among those supplemented with 5 mg of folic acid than among those given a placebo. 2) Incidence of CIN will be lower among those supplemented with 5 mg of folic acid than among those given a placebo. Secondary hypothesis: Lower levels of circulating and/or cervical cell folate, the presence of micronuclei, global DNA hypomethylation, integrated HPV 16, or a high viral load of HPV 16 in cervical cells at enrollment will reduce the effectiveness of folic acid supplementation on HPV clearance and on prevention of the progression of cervical lesions (less than CIN 1) to CIN 2 or 3. This will be the first intervention trial designed to evaluate folate's effects on specific types of HR-HPV, its protective role in HR- HPV associated incidence of CIN, and the mechanisms of action of folate on the behavior of HR-HPV. It will aid greatly in understanding the mechanisms of action of folate in cervical carcinogenesis. Public information: Infection with certain types of human papillomaviruses (HPVs), which are sexually transmitted, is considered a necessary step in the genesis of cervical intraepithelial neoplasia (CIN), precursor lesions for cervical cancer (CC). Control of these infections would offer a cost-effective long-term strategy to reduce the CC burden. Our recently completed studies strongly suggest that supplementation with a safe vitamin (folic acid) may reduce the HPV associated risk of CC. Because this study will be conducted among women positive for HPV 16, the most prevalent and powerful causative agent of CC, the public health significance of this study could be enormous and will complement HPV vaccine studies.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA102489-05
Application #
7841875
Study Section
Chemo/Dietary Prevention Study Section (CDP)
Program Officer
Ross, Sharon A
Project Start
2006-07-01
Project End
2014-05-31
Budget Start
2010-06-01
Budget End
2014-05-31
Support Year
5
Fiscal Year
2010
Total Cost
$482,688
Indirect Cost
Name
University of Alabama Birmingham
Department
Nutrition
Type
Schools of Allied Health Profes
DUNS #
063690705
City
Birmingham
State
AL
Country
United States
Zip Code
35294
Piyathilake, Chandrika J; Badiga, Suguna; Chambers, Michelle M et al. (2016) Accuracy of urinary human papillomavirus testing for the presence of cervical human papillomaviruses and higher grades of cervical intraepithelial neoplasia. Cancer 122:2836-44
Piyathilake, Chandrika J; Ollberding, Nicholas J; Kumar, Ranjit et al. (2016) Cervical Microbiota Associated with Higher Grade Cervical Intraepithelial Neoplasia in Women Infected with High-Risk Human Papillomaviruses. Cancer Prev Res (Phila) 9:357-66
Badiga, Suguna; Chambers, Michelle M; Huh, Warner et al. (2016) Expression of p16INK4A in cervical precancerous lesions is unlikely to be preventable by human papillomavirus vaccines. Cancer 122:3615-3623
Piyathilake, Chandrika J; Macaluso, Maurizio; Chambers, Michelle M et al. (2014) Folate and vitamin B12 may play a critical role in lowering the HPV 16 methylation-associated risk of developing higher grades of CIN. Cancer Prev Res (Phila) 7:1128-37
Piyathilake, Chandrika; Eom, Sang Yong; Hyun, Taisun et al. (2013) Determinants of neural tube defect (NTD)-protective circulating concentrations of folate in women of child-bearing age in the US post-folic acid fortification era. Nutr Res Pract 7:315-25